Down syndrome (DS) is the most common chromosomal disorder and a significant cause of intellectual disability, with children at increased risk for hearing loss. This study investigates the prevalence and characteristics of conductive hearing loss in Indian children with DS. Fifty children with karyotypically confirmed DS, aged 2 to 18 years, were examined at a tertiary care hospital. Otolaryngological assessments included evaluations of the external ear and tympanic membrane. Audiometric evaluations involved pure tone audiometry (PTA), impedance audiometry, and brainstem evoked response audiometry (BERA). Interventions like wax removal and tympanostomy tube placement were performed as needed, with follow-ups after three months. Conductive hearing loss was found in 72% of participants. Common issues included impacted cerumen (66%) and tympanic membrane retraction (34%). Sixteen patients received wax removal, and 7 of 17 with serous otitis media underwent tympanostomy tube placement. Significant improvements in hearing thresholds were observed post-intervention. The high prevalence of conductive hearing loss and ear abnormalities in children with DS highlights the need for regular audiological evaluations and timely interventions to enhance educational outcomes and quality of life.